A team of researchers at Dartmouth’s Geisel School of Medicine and New York University (NYU) Grossman School of Medicine has received a $4 million grant from the National Institute on Aging to improve “triadic” interactions between patients living with dementia, their care partners, and their clinicians.
An estimated 6.5 million Americans aged 65 or older currently live with Alzheimer’s disease or Alzheimer’s disease-related dementia, and that number is projected to rise to nearly 13 million by 2050, placing an even greater burden on patients, caregivers, and the healthcare system.
People living with dementia and their care partners (typically family members or friends) rely on primary care clinic visits for information about their disease, its management, and community referrals. While research has shown that quality interpersonal communication is associated with improved health outcomes, the degree to which effective communication is achieved during triadic visits is unknown, and few interventions have been developed to support it.
The main objective of the grant project, named VOiCES³, is to design an intervention that enhances interpersonal communication in triadic visits using audio recordings.
“The use of audio recordings in clinic visits is a novel, evidence-based strategy that we believe has great potential to improve the quality of communication in triadic visits, but its application is unexplored in dementia care,” explains Paul Barr, PhD, an associate professor of The Dartmouth Institute for Health Policy and Clinical Practice who is co-principal investigator on the study along with Joshua Chodosh, MD, director of the Division of Geriatric Medicine and Palliative Care and the Michael L. Freedman Professor of Geriatric Research at NYU Grossman School of Medicine.
The five-year study, consisting of three phases, will recruit patients living with dementia and their care partners from two sites: Dartmouth Hitchcock Medical Center (DHMC) in Lebanon, NH, and the Family Health Center in Brooklyn, NY, which is the second largest Federally Qualified Health Center in the U.S. and is affiliated with NYU Langone Health.
In phase one, the research team will recruit 200 patients (and their care partners)—100 from DHMC and 100 from the Family Health Center. The team will record and analyze primary care visits for each patient/care provider over the course of 12 months and will also conduct follow-up interviews to identify factors that both contribute to and detract from quality interactions.
In phase two, the investigators will apply what they learned in phase one to refine, through user-design sessions, their HealthPAL system—an audio health library designed for patients and their caregivers to record and access easy-to-navigate recordings of clinic visits. Developed by Barr and his research team, HealthPAL utilizes natural language processing to organize important information in visits and connect this to trustworthy, easy-to-understand content for patients.
“In phase three, we’ll recruit an additional 30 patients and their care partners (15 at each site) to conduct a pilot study so that we can assess the acceptability, usability, and potential effectiveness of our adapted HealthPAL system as a tool for enhancing interpersonal communication in triadic visits in the future,” says Barr, who is also a member of the Center for Technology and Behavioral Health at Dartmouth. “If things go well, we’ll then test the new version in larger trials.”
Importantly, says Barr, the project will utilize the expertise of scientists, clinicians, patients, and care partners across both health systems. “I am fortunate to collaborate with such a generous, talented, and committed team—it makes this vital work a joy to undertake,” he says.
The multidisciplinary study team includes James O’Malley, PhD (The Dartmouth Institute), Martha Bruce, PhD (Department of Psychiatry, Geisel), Elizabeth Carpenter-Song, PhD (Department of Anthropology, Dartmouth College), Nick Jacobson, PhD (Center for Technology and Behavioral Health), Gina Fernandez, MD (Geriatrics, Dartmouth Hitchcock Medical Center), and Yi Shan Lee, MD (Geriatric Medicine, NYU Langone Health).
“At the end of five years, our goal is to have a deep understanding of those interpersonal communications,” says Barr. “The novel intervention that we will develop—use of visit recordings—and the diverse and extensive data we will collect will serve as a unique resource that can be leveraged to address other gaps in clinical knowledge related to the care of people with dementia.”
“We also hope to identify best strategies that may benefit both patients and clinicians in caring for persons living with dementia,” says Chodosh.
“It’s such an important condition to address,” Barr says. “If we can find ways to improve how those conversations happen, while maintaining the respect and dignity of the patient and supporting the care partner and clinician in the process, we are confident we can make a positive difference in the care of millions of people living with dementia.”
Founded in 1797, the Geisel School of Medicine at Dartmouth strives to improve the lives of the communities it serves through excellence in learning, discovery, and healing. The Geisel School of Medicine is renowned for its leadership in medical education, healthcare policy and delivery science, biomedical research, global health, and in creating innovations that improve lives worldwide. As one of America’s leading medical schools, Dartmouth’s Geisel School of Medicine is committed to training new generations of diverse leaders who will help solve our most vexing challenges in healthcare.